Client Intake Form
and
Sending Assessment Photos

I can have a more complete understanding of your situation if
you fill out my intake form and send photos.

Links to the  intake form will also be on your session confirmation email.

The more carefully you fill out the form,
the better you and I will understand your situation.

It helps if I receive the form before your session.

Fillable PDF Version of
Eric Cooper Somatics Intake Form

[download fillable client info form] (5.2mb)

1. The form will require about 30-45 minutes to fill out thoroughly.
2. Fill out the form in a non-browser application (Use Preview on a Mac).
3. –>> Fill out a few lines and do a test save to ensure your info is being saved properly.
4. Save the filled-out form as a PDF (usually available as an option in the print dialog box).
5. Email it back to me as an attachment at eric@inspiresomatics.com before your session so I can study up.
   Note: Email is not entirely secure. If you choose to email your form, it is your decision. Do not enter any information that should only be sent through a secure channel.

-OR-

Printable PDF Version of
Eric Cooper Somatics Intake Form

[download printable client info form] (5.2mb)

1. The form will require about 30-45 minutes to fill out thoroughly.
2. If you don’t have a printer, let me know and I can mail the form to you.
3. If filling out the form is a hassle, don’t worry—we can still have a great session without it.
4. Email photos or scans of the completed form to eric@inspiresomatics.com before your session.
   Note: Email is not entirely secure. If you choose to email your form, it is your decision. Do not enter any information that should only be sent through a secure channel.

How to Send Photos

Photographs are very helpful for me to see some of the patterns that affect your body.

1. Wear fitted clothing, not too baggy. Please take the photos with clothes ON.
2. Take the photos with the camera at belly button height.
3. Stand in front of a door, showing the top, sides, and bottom of the door. This helps me correct any camera distortion (parallax error).
4. Stand naturally, as if waiting in line for 30 minutes. Don’t try to stand up straight—let your posture reflect how you truly stand. Slump, shrug, protrude, be crooked. Give in to your posture as it wants you to be.
5. Send photos that show you standing from the Front, Back, and Sides.
6. Ensure your hair is not covering your neck or shoulders in the front view.
7. If you typically place more weight on one leg when standing, if you have a preference for how you do that,
   send additional front and back photos showing this. Settle into it. Let the other leg go out to the side.
8. Email the photos as attachments to eric@inspiresomatics.com.
   Note: Email is not entirely secure. If you choose to email your form, it is your decision. Do not enter any information that should only be sent through a secure channel.

Please don’t overwhelm me with pages and pages of medical history.

Your history is important, but what’s happening in the present is most critical. I don’t need your entire story, just a brief summary. Similarly, I don’t need a detailed list of medications, just a general idea of what they are treating.